Cardiopulmonary Resuscitation (CPR) is a life-saving technique used when someone’s breathing or heart has stopped. It involves chest compressions and rescue breaths to circulate oxygen-rich blood to the brain and other organs. Assessing circulation, typically through a pulse check, is a component of CPR protocols, with specific frequency and methods to maximize effectiveness and patient outcomes.
Understanding Pulse Checks in CPR
A pulse check in CPR involves feeling for a heartbeat to determine if the heart is effectively pumping blood. This assessment helps rescuers decide if CPR is still necessary or if spontaneous circulation has returned. For adults and children, the carotid artery in the neck is the location to check for a pulse.
In infants, the brachial artery, located on the inside of the upper arm, is the preferred site. Rescuers use two or three fingers to gently press and feel for a rhythmic sensation.
Current Recommendations for Pulse Check Frequency
The frequency of pulse checks during CPR varies based on the rescuer’s training level. For lay rescuers, current guidelines advise against routine pulse checks to avoid delaying chest compressions. If a lay rescuer is unsure whether a person has a pulse, they should proceed with chest compressions.
For trained healthcare providers, a pulse check is performed after an initial assessment and then approximately every two minutes during CPR cycles. This check should be brief, lasting no more than 10 seconds. This strict time limit minimizes interruptions in chest compressions, which are important for maintaining blood flow. If a pulse is not detected within this 10-second window, or if there is any doubt, CPR should be immediately resumed.
Actions Based on Pulse Check Results
The outcome of a pulse check dictates the immediate next steps in CPR. If a pulse is present and the person is breathing normally, chest compressions should be stopped. The individual should then be monitored closely, and medical help should be awaited. If the person remains unconscious but is breathing and has a pulse, they may be placed in a recovery position to help maintain an open airway and prevent aspiration.
If no pulse is present, or if the rescuer is uncertain, chest compressions must be resumed immediately without delay. Continuing CPR, starting with compressions, is important in such situations. This ensures that blood flow to the brain and heart is maintained, maximizing the chance of a positive outcome.
The Priority of Continuous Chest Compressions
Current CPR guidelines emphasize the priority of continuous, high-quality chest compressions. Interruptions in compressions reduce blood flow to the brain and heart, which can negatively impact survival rates. Each pause in compressions leads to a drop in blood pressure and requires time to rebuild perfusion pressure once compressions resume.
Maintaining “hands-on time,” meaning the proportion of time spent performing chest compressions, is directly linked to improved outcomes. Even short pauses, such as those for pulse checks or rescue breaths, can be harmful. This understanding underpins the strict 10-second limit for pulse checks and the recommendation for lay rescuers to focus on continuous compressions, prioritizing the uninterrupted flow of blood to organs.